Performance evaluation of a whole-body PET scanner using the NEMA protocol. National Electrical Manufacturers Association

This study evaluates the performance of the newly developed high-resolution whole-body PET scanner ECAT EXACT HR+. METHODS: The scanner consists of four rings of 72 bismuth germanate block detectors each, covering an axial field of view of 15.5 cm with a patient port of 56.2 cm. A single block detector is divided into an 8 x 8 matrix, giving a total of 32 rings with 576 detectors each. The dimensions of a single detector element are 4.39 x 4.05 x 30 mm3. The scanner is equipped with extendable tungsten septa for two-dimensional two-dimensional measurements, as well as with three 68Ge line sources for transmission scans and daily quality control. The spatial resolution, scatter fraction, count rate, sensitivity, uniformity and accuracy of the implemented correction algorithms were evaluated after the National Electrical Manufacturers Association protocol using the standard acquisition parameters. RESULTS: The transaxial resolution in the two-dimensional mode is 4.3 mm (4.4 mm) in the center and increases to 4.7 mm (4.8 mm) tangential and to 8.3 mm (8.0 mm) radial at a distance of r = 20 cm from the center. The axial slice width measured in the two-dimensional mode varies between 4.2 and 6.6 mm FWHM over the transaxial field of view. In the three-dimensional mode the average axial resolution varies between 4.1 mm FWHM in the center and 7.8 mm at r = 20 cm. The scatter fraction is 17.1% (32.5%) for a lower energy discriminator level of 350 keV. The maximum true event count rate of 263 (345) kcps was measured at an activity concentration of 142 (26.9) kBq/ml. The total system sensitivity for true events is 5.7 (27.7) cps/Bq/ml. From the uniformity measurements, we obtained a volume variance of 3.9% (5.0%) and a system variance of 1.6% (1.7%). The implemented three-dimensional scatter correction algorithm reveals very favorable properties, whereas the three-dimensional attenuation correction yields slightly inaccurate results in low- and high-density regions. CONCLUSION: The ECAT EXACT HR+ has an excellent, nearly isotropic spatial resolution, which is advantageous for brain and small animal studies. While the relatively low slice sensitivity may hamper the capability for performing fast dynamic two-dimensional studies, the scanner offers a sufficient sensitivity and count rate capacity for fully three-dimensional whole-body imaging.     

Lesion-to-background ratio in nonattenuation-corrected whole-body FDG PET images

The purpose of this study was to compare the diagnostic efficacy of attenuation-corrected and nonattenuation-corrected whole-body 18F-fluorodeoxyglucose (FDG) PET images to determine an adequate method that can semiquantitatively evaluate nonattenuation-corrected images. METHODS: Whole-body PET studies were performed in 24 fasting patients with various tumors (lung cancers, n = 18; mediastinal tumors, n = 4; breast cancers, n = 2) 30-40 min after a bolus injection of 18F-FDG. Transmission scans followed emission data acquisition. Reconstructed attenuation-corrected and uncorrected images were displayed simultaneously and the relative FDG uptake in lesions and corresponding background areas was evaluated by the region of interest method. Both types of images were also compared with X-CT scans and conventional nuclear medicine scans for diagnostic efficacy. RESULTS: Attenuation-corrected and uncorrected images were found to be equally sensitive for detecting lesions. There was a strong linear correlation between lesion-to-background (L/B) ratios calculated on attenuation-corrected and uncorrected images (r = 0.98; p < 0.001). Significant differences in L/B ratios between attenuation-corrected and uncorrected images were present in only 6 of 55 lesions (11%). Standardized uptake ratios (SURs) in attenuation-uncorrected images did not correlate with SURs in attenuation-corrected images nor with L/B ratios in uncorrected images. CONCLUSION: The efficacy of attenuation-uncorrected FDG PET images in evaluating tumors is similar to that using attenuation-corrected images. Uncorrected images provide not only clinically useful but also quantitative information equivalent to that provided by attenuation-corrected images. However the L/B ratio is the only available index that can be used for quantification of uncorrected images.     

Incremental beamwise backprojection using geometrical symmetries for 3D PET reconstruction in a cylindrical scanner geometry

Cho et al have proposed a fast backprojection scheme for parallel beam geometries, the incremental algorithm, which performs backprojection on a ray-by-ray (beam-by-beam) basis as opposed to a pixel-by-pixel approach. We present an extension of this incremental, beamwise, backprojection algorithm to the case of volume reconstruction of data acquired by a cylindrical, multiring positron tomograph. Use is made of geometrical symmetries of the image volume. This method results in a twelve-fold reduction of execution time compared with a straightforward, voxel-driven implementation of the same interpolation equations.     

A rotating PET scanner using BGO block detectors: design, performance and applications

Recent advances in fully three-dimensional reconstruction for multi-ring PET scanners have led us to explore the potential of a prototype scanner based on the rotation of two opposing arrays of BGO block detectors. The prototype contains only one-third of the number of detectors in the equivalent full ring scanner, resulting in reduced cost. With a lower energy threshold at 250 keV, the absolute efficiency of the scanner is 0.5% and the scatter fraction is 35% for a 20-cm cylinder. Transaxial and axial spatial resolution is about 6 mm. The maximum noise equivalent count rate estimated for a 15-cm diameter cylinder is 36,000 cps at a concentration of 26 kBq/ml. The minimum scan time for a 18F-fluoro-2-deoxyglucose (FDG) brain study is 55 sec. The camera has been validated for clinical applications using both FDG and 82Rb.     

Performance characteristics of a new synthetic APTT reagent

The question of whether the use of a teaching strategy employing simulation influences attitudes toward disabled persons over time was addressed in this quasi-experimental intervention study. The experimental group participated in "Sensitivity Day" which incorporated a simulation activity. A total of 77 undergraduate baccalaureate nursing students completed the Attitudes Toward Disabled Persons scale four times: presimulation, immediate postsimulation, six week delayed postsimulation and six month delayed postsimulation. In general, the nursing students had relatively positive scores on the Attitudes Toward Disabled Persons scale in each testing period. The best indicator of postsimulation attitude scores was the presimulation attitude score. Personal and prior nursing experience had no statistical effects on attitude. Improvement that was significant at p = .07 level was noted in the experimental group at the six weeks delayed postsimulation when compared with the presimulation attitude scores. This study supplies data that is useful in constructing learning activities and contributes to the body of knowledge about simulation and attitudes toward persons with disabilities.     

Performance characteristics of a chemical imaging time-of-flight mass spectrometer

A chemical imaging time-of-flight secondary ion mass spectrometer is described. It consists of a liquid metal ion gun, medium energy resolution reflectron mass analyzer, liquid nitrogen cooled sample stage, preparation chamber and dual stage entry port. Unique features include compatibility with laser postionization experiments, large field of view, cryogenic sample handling capability and high incident ion beam current. Instrument performance is illustrated by the characterization of scanning electron microscopy grids, silver and functionalized polystyrene beads and the postionization of an organic overlayer on a gold substrate.     

Performance of a randomization test for single-subject (15)O-water PET activation studies

We adapted and implemented a permutation test (Holmes 1994) to single-subject positron emission tomography (PET) activation studies with multiple replications of conditions. That test determines the experimentwise alpha error as well as location and extent of focal activations in each individual. Its performance was assessed in five normal volunteers, using (15)O-H2O-PET data acquired on a high-resolution scanner, with septa retracted (3D mode), during functional activation by repeating words versus resting (four replications each). Calculated alpha errors decreased and the size of activated tissue volumes (voxels with P < or = 0.05) increased with increasing filter kernel size applied to the difference images. At a filter kernel of 12 mm Gaussian full width at half maximum, significant focal activations were seen bilaterally in superior temporal cortex, including Brodmann's areas 41 and 42, in all five subjects. Additional foci were detected in the precentral gyrus, left inferior frontal gyrus, supplementary motor area, and cerebellum of several subjects. The average CBF increase in activated voxels ranged from 17.6% to 28.7%. Activated volumes were smaller than those detected with a standard parametric test procedure. We conclude that the permutation test is a less sensitive procedure, having the advantage of not depending on unproven distributional assumptions, that detects strong activation foci in individual subjects with high reproducibility.     

Measurement of the volume of a leg ulcer using a laser scanner

BACKGROUND AND AIMS: Uroporphyrin and protoporphyrin produce alterations on 5-aminolevulinic acid dehydratase and porphobilinogen deaminase, as a result of a direct effect of porphyrins on the protein structure. With the aim of assessing the possible protection from the porphyrins effect on the proteins, some chemicals and the enzyme substrates were assayed. METHODS: Enzymes were pre-incubated with the protecting agents (beta-mercaptoethanol, dithiotreitol, hydroxylamine, succinic anhydride) or the corresponding substrates (delta-aminolevulinic acid and porphobilinogen), and then exposed to the porphyrins. All experiments were performed in the enzyme solutions after removing the porphyrins. RESULTS: The presence of sulfhydryl reagents partially protected both the enzyme activities and the content of total SH and free amino groups, but they did not prevent the appearance of molecular aggregates in the electrophoresis. Similar results were obtained in the presence of the corresponding substrates. Nucleophilic addition of hydroxylamine to the aromatic amino acids on the enzymes and blockage of their free amino groups did not prevent the direct effect of porphyrins, but these agents protected the enzyme activities from the photodynamic action of the tetrapyrroles, and also prevented the formation of molecular aggregates. However, an increased amount of free amino groups was observed, probably due to protein fragmentation. CONCLUSIONS: Porphyrins mainly affected the SH groups at or near the active site of the enzymes. Most of the free amino groups on the treated enzymes were involved in the formation of cross-links among the protein molecules. Protein fragmentation induced by porphyrins under UV light, and the consequent increased amount of free amino groups, were observed.     

Lymphoma: role of whole-body 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) PET in nodal staging

PURPOSE: To compare 2-deoxy-2-[fluorine-18]fluoro-D-glucose (FDG) positron emission tomography (PET) with computed tomography (CT) in primary nodal staging of malignant lymphoma. MATERIALS AND METHODS: Sixty consecutive patients with untreated, histopathologically proved malignant lymphoma (aged 7-72 years; 33 with non-Hodgkin lymphoma, 27 with Hodgkin disease) underwent FDG PET and contrast material-enhanced CT for nodal staging. Lymph node regions identified at both CT and PET were regarded as actual locations of disease. Discordant results were verified with biopsy or clinical follow-up whenever possible. RESULTS: One hundred sixty of 740 evaluated lymph node regions were identified as diseased at both CT and PET. Of the 25 additional regions seen with PET, seven were true-positive; two, false-positive; and 16, unresolved. CT showed six additional disease manifestations; three were false-positive, and three were unresolved. Staging was changed in the four patients with the seven confirmed additional PET findings: from stage I to II in one patient and from stage II to III in three patients. Staging was changed from stage II to I in one of the three patients with false-positive CT findings. CONCLUSION: FDG PET may be more accurate for detecting nodal lymphoma than incremental CT.     

Performance of the Fourier rebinning algorithm for PET with large acceptance angles

In order to assess the present situation of schistosomiasis in the Zona da Mata Sul, Pernambuco State, Brazil, a study was conducted in the following phases: origin, historical and temporal evolution, and basic determinants of this health/disease process; critical assessment of comprehensive intervention programs implemented by the State in the region since 1970; and a case study in 17 counties, representing 1,424 communities and 485,200 inhabitants, and Brazil's second most endemic region based on prevalence rates for schistosomiasis. Temporal series over a 14-year period were used to analyze results of intervention programs. Conclusions were: a) current positivity rates are higher than those observed in the early 1980s; b) the programs' strategy focused almost exclusively on mass treatment, thus allowing for reinfestation and occurrence of new cases; c) proposals such as the PCDEN (Program for Control of Endemic Diseases in the Northeast) aimed at decentralization to the municipal level in the 1990s were not effectively implemented, helping to leave this persistent endemic out of control.     

Peripheral nerve stimulation in a whole-body echo-planar imaging system

Echo-planar techniques in MRI use a rapidly oscillating frequency-encoding gradient with the potential to produce peripheral nerve stimulation. To evaluate the incidence, type, and location of stimulation in a commercial whole-body scanner, we studied two groups: (a) 173 consecutive individuals scanned by echo-planar imaging for other purposes and (b) seven subjects who were scanned with an extensive set of 36 echo-planar sequences (with prompting after each scan to report any peripheral nerve stimulation) to test the effects of various parameters. Although only 5% of group A reported symptoms of peripheral nerve stimulation, all in group B experienced some type of stimulation, dependent primarily on direction of the oscillating gradient and location of the body within the gradient coil. Maximum stimulation typically occurred 30 to 40 cm from isocenter in the region of maximum dB/dt. Generally, y gradients produced truncal stimulation, and x gradients produced stimulation in the head. When hands were clasped over the abdomen, a tingling in the hands occasionally was felt. Patients should be instructed to keep their hands apart.     

Ultrasound imaging of nasal bone fractures with a 20-MHz ultrasound scanner

High frequency B-scan ultrasonography is a proven method for the assessment of skin tumors and evaluation of the thickness of skin and cartilage layers. Only limited studies have used sonography to examine bony structures. Our goal was to evaluate the importance of ultrasonography in the diagnosis of nasal fractures. Patients with clinical and/or radiological evidence for such fractures were also examined with 20 MHz B-scan ultrasonography. Results of sonography demonstrated a significant correlation with the nasal fractures present, indicating that additional radiographic examinations are unnecessary in certain cases.     

Measurement of lumbar spine flexion-extension using a low-field open-magnet magnetic resonance scanner

RATIONALE AND OBJECTIVES: The authors investigated the feasibility of using a low-field open-magnet magnetic resonance (MR) scanner to acquire functional flexion-extension images for range of motion (ROM) measurements on the lumbar spine. METHODS: Seventeen healthy subjects with no symptoms of back pain (age range, 22-59 years) were scanned in a low-field open-magnet MR scanner in the flexed, neutral, and extended positions. Each image was downloaded to a computer workstation for subsequent flexion-extension, lordosis, and ROM measurement. RESULTS: Data from two subjects were not analyzed because their images did not show all the lumbar vertebrae. For the remaining 15, there was a large variation in the magnitude of the ROM values (range, 9 degrees-70 degrees; mean 36.4 degrees, SD 16.5 degrees). However, there was a significant correlation between age and ROM (r = -0.63; P < 0.05). CONCLUSIONS: The low-field open-magnet MR scanner provides a method for noninvasive imaging of the lumbar spine, allowing the subject freedom of movement in the horizontal plane. This enables functional flexion-extension images of the lumbar spine to be acquired.     

Software upgrading in a CT scanner. Influence on quantitative CT

PURPOSE: In an attempt to improve field uniformity and CT number stability, the software in a CT scanner was replaced with a new version. The purpose of the present study was to investigate the influence of the software upgrading on density measurements. MATERIAL AND METHODS: The upgrading influence was investigated by means of a torso phantom (European spinal). The phantom simulates a torso which contains 3 vertebrae of different densities. RESULTS: Despite the use of a reference standard under the phantom, the software change resulted in: a) improved short-term precision; b) increased density values at 80 and 100 kVp, decreased at 130 kVp; and c) increased influence of the kVp on the values. CONCLUSION: The results of the present study suggest that conversion factors have to be used in density values for reference populations as well as in the values of patients undergoing follow-up studies.     

Functional magnetic resonance imaging of primary visual processing using a 1.0 Tesla scanner

Recent advances in functional magnetic resonance imaging (fMRI) at > or = 1.5 T magnetic field strength and with high speed single-shot echo planar imaging techniques have made it possible to monitor local changes in cerebral blood volume, cerebral blood flow, and blood oxygenation level in response to sensory stimulation, simple motor activity, and possibly also to more complex cognitive processing. However, fMRI has also been accomplished on conventional MR scanners of medium field strength (approximately 1.0 T) using special pulse sequences and appropriate methods for image analysis. We present results from six subjects on photic stimulation using a standard 1.0 T MR scanner together with special software for off-line image analysis. Continuous serial T2-weighted imaging were performed for 6 minutes in the plane of the calcarine fissure. There were 3 repetitions of 1 minute resting state of darkness (OFF) and 1 minute activated state (ON) with 8 Hz flicker stimulation. To directly map these functional images to the underlying anatomy we also acquired a high resolution T1-weighted image from the same axial slice. The results demonstrated that stimulus-related signals can be obtained from primary visual cortex with a conventional 1.0 T MR scanner. Further methodological improvements are discussed and related to present and future possibilities for the use of fMRI within psychophysiology.     

Application of a semi-automatic ROI setting system for brain PET images to animal PET studies

ProASSIST, a semi-automatic ROI (region of interest) setting system for human brain PET images, has been modified for use with the canine brain, and the performance of the obtained system was evaluated by comparing the operational simplicity for ROI setting and the consistency of ROI values obtained with those by a conventional manual procedure. Namely, we created segment maps for the canine brain by making reference to the coronal section atlas of the canine brain by Lim et al., and incorporated them into the ProASSIST system. For the performance test, CBF (cerebral blood flow) and CMRglc (cerebral metabolic rate in glucose) images in dogs with or without focal cerebral ischemia were used. In ProASSIST, brain contours were defined semiautomatically. In the ROI analysis of the test image, manual modification of the contour was necessary in half cases examined (8/16). However, the operation was rather simple so that the operation time per one brain section was significantly shorter than that in the manual operation. The ROI values determined by the system were comparable with those by the manual procedure, confirming the applicability of the system to these animal studies. The use of the system like the present one would also merit the more objective data acquisition for the quantitative ROI analysis, because no manual procedure except for some specifications of the anatomical features is required for ROI setting.     

Two-dimensional echocardiography with a wide angle (60 degrees) sector scanner

A wide angle (60 degrees) sector scanner producing a real-time two-dimensional echocardiogram has been used to examine healthy infants, children, and adults. Its method of use is described and findings from longitudinal and transverse scans are presented. The points of difference between the various types of electronic and mechanical two-dimensional scanning systems are discussed. This equipment minimises problems of chest contact and rib and lung interference and, by providing echocardiograms of high line density from a wide angle, is a suitable real-time two-dimensional scanning system for examining patients of all ages.     

Performance evaluation of the Pico-Count flow-through detector for use in cerebral blood flow PET studies

With the emergence of fungi as important nosocomial pathogens, increasing reports of antifungal resistance, and expanding drug therapy options, the need for clinically relevant antifungal susceptibility testing is evident. Over the last decade, the National Committee for Clinical Laboratory Standards (NCCLS) worked to standardize procedures for in vitro susceptibility testing of Candida species against fluconazole, itraconazole, 5-fluorocytosine, and amphotericin B. With the establishment of a reproducible methodology, correlation of antifungal susceptibility in vitro with clinical outcome is a priority. The NCCLS proposed susceptibility breakpoints for the three agents against Candida species, with breakpoints for amphotericin B forthcoming. These breakpoints could provide useful guidance in some clinical situations involving azole or 5-fluorocytosine therapy; however, routine susceptibility testing of fungal isolates should be discouraged.     

CT densitometry of the lungs: scanner performance

OBJECTIVE: Our goal was to establish the reproducibility and accuracy of the CT scanner in densitometry of the lungs. MATERIALS AND METHODS: Scanner stability was assessed by analysis of daily quality checks. Studies using a humanoid phantom and polyethylene foams for lung were performed to measure reproducibility and accuracy. The dependence of the CT-estimated density on reconstruction filter, zoom factor, slice thickness, table height, data truncation, and objects outside the scan field was determined. RESULTS: Stability of the system at air density was within approximately 1 HU and at water density within approximately 2 HU. Reproducibility and accuracy for densities found for lung were within 2-3%. Dependence on the acquisition and reconstruction parameters was neglible, with the exceptions of the ultra high resolution reconstruction algorithm in the case of emphysema, and objects outside the scan field. CONCLUSION: The performance of the CT scanner tested is quite adequate for densitometry of the lungs.     

ECAT ART - a continuously rotating PET camera: performance characteristics, initial clinical studies, and installation considerations in a nuclear medicine department

The past decade has been characterized by few advances regarding the pathophysiology and prevention but many changes in the clinical treatment of patients with preeclampsia. Specifically, recommendations have been made for home or day-care management of a select group of patients with mild gestational hypertension or preeclampsia. Moreover, three randomized clinical trials revealed that expectant management with close monitoring of maternal and fetal conditions is possible in a select group of patients with severe preeclampsia at less than 34 weeks' gestation. In addition, the efficacy of magnesium sulfate in the prevention and control of eclamptic convulsion has been validated in randomized controlled trials performed worldwide. In contrast, recent randomized trials failed to demonstrate any major benefit from the routine use of low-dose aspirin in pregnancy, whereas a recent meta-analysis found calcium supplementation during pregnancy to be effective in reducing the risk of hypertension.